The efficacy of topical adipose mesenchymal stem cell-conditioned medium versus framycetin gauze dressing in chronic plantar ulcer of leprosy: A randomized controlled trial.

Background Wound healing shows a unique interaction of several cells, growth factors and cytokines. The healing of chronic plantar ulcer of leprosy is influenced by various factors, one of which is the concentration of growth factors and cytokines related to the pathogenesis of impaired wound healing. Growth factors and cytokines can be found in the secretome of adipose mesenchymal stem cells. Aim To compare the effectiveness of topical adipose mesenchymal stem cell-conditioned medium and framycetin gauze dressing only on the healing of chronic plantar ulcer of leprosy. Methods In this randomised controlled trial, 32 patients with chronic plantar ulcer of leprosy were recruited. After detailed clinical and initial debridement, patients were randomised to two groups to receive either topical adipose mesenchymal stem cell-conditioned medium (n = 16) or framycetin gauze dressing only (n = 16) applied every three days for up to eight weeks, following which the ulcer size, adverse reactions and complications if any were monitored weekly. Results Healing percentage increased each week in all groups. Statistical differences between groups (P < 0.05) were observed from week 2 onwards for ulcer mean size reduction and from week 3 onwards for ulcer mean depth reduction. There were no adverse reactions or complications. Limitations Off-loading on subjects were not performed. Conclusion Adipose mesenchymal stem cell-conditioned medium is a potential therapeutic agent in the management of chronic plantar ulcer of leprosy.

Double atypical co-infection in ecthyma gangrenosum: a peculiar case report.

Introduction: Ecthyma gangrenosum (EG) is a rare cutaneous manifestation commonly associated with Pseudomonas aeruginosa infection in immunocompromised individuals. Additionally, different bacterial and fungal pathogens have also been identified. However, co-infection on EG lesions has never been reported before. Case report: We present the case of a seven-year-old female Asian patient who initially was diagnosed with febrile neutropenia. Initially, on the sixth day of admission, dermatological status revealed multiple painless erythematous macules on the face and arms together with persistent fever followed by evolution to multiple black, deep-seated, and large central eschars and early identification of Pseudomonas aeruginosa in the blood culture. Further evaluation revealed the development of EG with XDR Acinetobacter baumannii and Aspergillus spp. isolated from the samples harvested intraoperatively. Conclusions: Specific identification of etiological agents will serve its importance for early diagnosis, aggressive antibiotic treatment, and/or surgical intervention to improve the prognosis.

A High Distribution of Resistant Pathogens among Critically Ill Neonates from Secondary Referral Hospital of Indonesia.

BACKGROUND: The spread of resistant pathogens among critically ill neonates has increased in recent years. Therefore, information about the antimicrobial profile and its susceptibility over time helps to select the most appropriate therapy. The study assesses the distribution of resistant pathogens and its susceptibility among neonates' patients. METHODS: Eight hundred and eight suspected neonatal infected from January 2011 to December 2019 were recruited anonymously in our retrospective, observational analysis. The study was conducted in the secondary-care level NICU which located on the western border of Jakarta, Indonesia. The MDROs definition was define by Centre for Disease Prevention and Control (CDC) criteria and standardized international terminology. Microbial identification and susceptibility testing were carried out following standard protocols. RESULTS: Culture positivity was found in 132 (16.3%) with dominating MDR-Gram negative bacteria 47 (61.8%). The most common pathogens were extended-spectrum ß-lactamase and multidrug-resistant Acinetobacter 18 (38.3%), respectively. There were coagulase negative staphylococci 29 (38.2%) among MDROs. Most of the Gram negative bacteria were highly susceptible to the combination of cefoperazone/sulbactam (79.6%), amikacin (88.7%), and tigecycline (77.1%). Staphylococcus aureus had a good susceptibility to almost all classes' antibiotics. Candida isolates showed 100.0% susceptibility to all antifungal classes. CONCLUSIONS: Our study highlighted the microbial profile along with its susceptibility among neonatal patients that able to provide necessary information for antimicrobial guidelines and policies for effective infectious case management.

Knowledge, attitudes and practices regarding rabies among community members: a cross-sectional study in Songan Village, Bali, Indonesia.

BACKGROUND: Rabies is a preventable yet endemic zoonotic disease caused by a neurotrophic virus, a member of Rhabdoviridae family. Rabies remains a public health threat in Indonesia, specifically Bali Province. The present study aimed to understand the knowledge, attitudes and practices (KAP) regarding rabies among community members in Songan Village, Bali, Indonesia. MATERIALS AND METHODS: We conducted a cross-sectional survey using a structured questionnaire among 175 community members residing in the administrative area of public health centre of Kintamani V in Songan Village of Bangli District, from December 2019 to February 2020. Statistical analyses were performed with SPSS software, version 21. RESULTS: Of the 175 community members, 53 (30.3%) owned a dog. Majority of the respondents were Hindu (98.8%), female (56.0%), aged ≥ 29 years old (54.9%), with an educational background of higher secondary (28.6%), residing in Songan A and B residential village (86.9%), working as farmers (50.9%), with the level of income less than district minimum wage (71.4%). The KAP scores mean ± standard deviation were 6.93 ± 1.83 and 8.04 ± 1.07 (out of 10), respectively. Multivariable logistic regression models were constructed and the KAP of the community members was found to be significantly influenced by occupation (p-value < 0.05). CONCLUSIONS: Albeit community members demonstrated some level of KAP regarding rabies, overall, this study revealed critical gaps in their fundamental knowledge of rabies, the prevention in dogs, and the local rules and regulations concerning rabies. In accordance with One Health Approach, further enforcement on the collaborative efforts for comprehensive education programmes, scheduled mass vaccination for dogs, and promotion for healthier attitudes and practices are recommended.

GeneXpert Mycobacterium tuberculosis/rifampicin assay for molecular epidemiology of rifampicin-Resistant Mycobacterium tuberculosis in an Urban Setting of Banten province, Indonesia.

Background: Tuberculosis (TB) is the fourth leading cause of death in Indonesia. In 2017, the World Health Organization (WHO) estimated that only 2% of the TB patients in Indonesia had only been tested with rapid diagnostics at the time of diagnosis, resulting in largely underdetected rifampicin-resistant TB (RR-TB). Utilization of GeneXpert Mycobacterium tuberculosis/rifampicin (MTB/RIF) assay as a point-of-care molecular assay to detect TB and RR-TB and serving its purpose in accordance with the first pillar of the WHO End-TB Strategy. Objective: This study investigated the use of GeneXpert MTB/RIF assay to determine the molecular epidemiology of RR-TB in an urban setting of Indonesia. Methods: All molecular epidemiological and microbiological databases were retrospectively examined from GeneXpert MTB/RIF assay results in Siloam Hospital Lippo Village. The sociodemographic characteristics and results of microbiological examinations consisting of Ziehl-Neelsen staining and GeneXpert MTB/RIF assay were analyzed. Results: During the study period, 600 cases were registered, and GeneXpert MTB/RIF tests were done in which the tests yielded 597 (99.5%) valid results; 62.0% were male and adult of age category; of whom 29 samples (4.9%) were found to be RR-TB, 186 samples (31.2%) were RIF sensitive, and remainders were negative. Conclusions: The results of GeneXpert MTB/RIF to be a fundamental diagnosis of RR-TB and subsequently to notify MDR-TB were satisfying and valuable in this study. This further increased and reinforced TB surveillance and national TB program to finally bring about WHO end-TB strategy one step closer in Indonesia.